County of Essex declares local emergency over ambulance offload delays

The County of Essex has declared a local emergency in response to persistent ambulance offload delays.

County officials say the delays are causing situations when there are no ambulances or only a limited number of ambulances available to respond to emergency calls.

Warden Gary McNamara activated the declaration at 8:45 a.m. Monday. Warden McNamara and Essex-Windsor EMS Chief Bruce Krauter then held a press conference at the Tecumseh EMS Base. Local municipalities, including the City of Windsor, and local hospitals and health-care partners have been alerted.

Warden Gary McNamara and Essex-Windsor EMS Chief Bruce Krauter at a press conference at the Tecumseh EMS Base in Tecumseh, Ont., on Monday, Oct. 17, 2022. (Chris Campbell/CTV News Windsor)

“Essex-Windsor EMS has worked with our local hospital partners to reduce offload delays but the problem persists, putting patients at risk and negatively affecting the morale of paramedics,” said McNamara. “We are activating this local state of emergency so we can do everything we can to keep our paramedics on the road responding to emergency calls instead of sitting outside of congested hospitals.”

County officials say the frequency and duration of offload delays has risen sharply since 2020, creating situations where multiple ambulances are forced to idle for hours at a time outside hospital emergency rooms waiting for patients to be admitted. Sometimes those delays last longer than 12 hours.

CUPE Paramedics of Windsor-Essex supported the move to declare an emergency on social media on Monday.

“The declaration really doesn't change much of what we're doing,” said Windsor Regional Hospital chief of staff Dr. Wassim Saad. “There's only so much we can do with the resources that we have.”

“There are only so many beds in the hospital, so many staff to look after those patients. But again, we're doing everything we possibly can to help patients through the emergency room.”

According to Saad, the hospital has already embedded an internal medicine specialist in the emergency room and have an emergency room physician in triage to assess patients upon arrival.

“This is not a one problem, one solution issue,” he said. “This is multifaceted, and I think again, something that's been a problem with our healthcare system for so long. It's just now been exposed as a result of the COVID pandemic and with human health resources dwindling as a result of the pandemic.” 

Thank you for stepping up and standing behind your Frontline! @EssexCountyON https://t.co/1kzGYFn0AL

— CUPE Paramedics of Windsor-Essex (@CupeMedics2974) October 17, 2022

Response from Windsor Regional Hospital

WRH officials say these challenges continue to strain our staff despite having close to 60 more acute care beds today than WRH had prior to COVID-19, as well as some 400 additional front-line clinical staff.

“This morning we have 38 total patients in the emergency departments without an inpatient bed available. As stated we are operating close to 60 acute care beds more today then pre COVID-19. No more space or staff available for more. We will continue to do all we can,” Windsor Regional Hospital said in a statement on Monday.

In order to provide context to the conversation in the wake of a declaration of emergency, WRH released the following statistics which provide a snapshot of our current patient volumes and challenges as of 9:45 am today (Monday, October 17, 2022):

• The occupancy level for medical/surgical patients at our Ouellette Campus is at 106%
• The occupancy level for medical/surgical patients at our Met Campus is at 107%
• There are 44 patients in our Emergency Departments who have been admitted to hospital but waiting for an in patient bed to become available (22 at Ouellette Campus and 20 at Met Campus)
• There are a total of 42 Alternate Level of care (ALC) patients in hospital (14 at Ouellette Campus and 28 at Met Campus). Of the 42 ALC, 27 are awaiting a LTC bed to become available.

WRH is anticipating additional patient volumes as flu season and any resurgence in COVID-19 cases arise this Fall.

Response from Minister of Health 

"We are continuing to collaborate with Ontario Health, local paramedic services, hospital leadership, and other sector partners on short- and long-term strategies that increase ambulance availability and reduce ambulance offload time," spokesperson Hannah Jenson said in a statement. 

"Our government’s four-part strategy to tackle ambulance offload time issues is focused on: returning ambulances to communities faster, providing timely and appropriate care in the community, facilitating non-ambulance transportation for stable patients, and increasing health care worker capacity. All of this with the goal of improving patient flow in hospital, reducing ambulance offload time, and avoiding unnecessary trips to emergency departments. It is why we have invested $23 million in the Dedicated Offload Nursing Program, allowing paramedics to get back into communities faster and expanding 9-1-1 models of care to empower paramedics to provide more appropriate and timely care in the community.

The Ministry has been in constant contact with Essex-Windsor hospital leaders, Ontario Health West, and Essex-Windsor EMS over the past year to collaborate on strategies to improve ambulance offload times. Minister Jones also plans on meeting with Warden McNamara and Essex-Windsor EMS Chief Bruce Krauter as soon as possible to discuss how the province can assist with this matter.

Our government continues to work in partnership with Essex-Windsor EMS to provide the support they need to maintain ambulance availability in their community. This includes providing an additional $280,000 to Windsor, Hamilton, and Niagara in 2021/22 to address immediate ambulance offload pressures. This funding was in addition to their Land Ambulance Services Grant of over $200 million and over $980 thousand in funding for the Dedicated Offload Nurses Program."

Code Black

Last Wednesday, Essex-Windsor EMS moved into code red status (two ambulances available) and then quickly into a code black (no ambulances are available) for a period of about three hours. Locally, 26 ambulances were rostered but all 26 were experiencing offload delays outside hospitals.

Historically, neighbouring ambulance services have been able to rely on each other for support when one region had higher than normal call volumes. But last Wednesday, services across southwestern Ontario were all experiencing intense pressures at the same time. Over one period of time, there were zero to seven ambulances available to cover the vast region from London to the Detroit River between lakes Erie and Huron.

“Our paramedics and our hospital partners are doing everything they can to respond to this crisis but the causes are complex and related to longstanding systemic issues including hospital capacity, patient flow and a lack of available local primary care providers,” said Krauter. “Essex Windsor EMS transports account for about 35 per cent of emergency room visits compared to a provincial average between 10 and 15 per cent. This is unsustainable.”

Krauter and County of Essex officials recently met with Ministry of Health officials to advance solutions to address the province-wide crisis.

Those suggestions included:

• Recognize offload delays as a public health risk.
• Create incentives for hospitals to meet 30-minute offload targets and enforce consequences for those that fail to meet the targets.
• Require hospitals to triage patients brought in by paramedics as a first priority – every time.
• Implement Fit-to-Sit programs: Allow low acuity patients brought in by ambulance to go to the waiting room so paramedics can get back on the road.
• Require hospitals to take a whole-hospital approach and develop escalation plans mobilizing all levels of the hospital to deal with emergency department surges and offload delays.
• Create standardized measurements and reporting between hospitals and paramedics to ensure consistent and accurate data collection to inform decisions.